
    <table style="color: black;">
        <tr>
            <td class="display">Name on card</td>
            <td><input name="cc_card_name" type="text" class="form-control" id="cc_card_name" /></td>
        </tr> 
        <tr>
            <td class="display">Credit Card Number</td>
            <td><input name="cc_card_number" type="text" class="form-control" id="cc_card_number" /></td>
        </tr>
        <tr>
            <td class="display">Expiration Date</td>
            <td>
            <select class="form-control credit-card" id="cc_expiration_month" name="cc_expiration_month">
         <option value="1">January</option>
          <option value="2">February</option>
          <option value="3">March</option>
          <option value="4">April</option>
          <option value="5">May</option>
          <option value="6">June</option>
          <option value="7">July</option>
          <option value="8">August</option>
          <option value="9">September</option>
          <option value="10">October</option>
          <option value="11">November</option>
          <option value="12">December</option>
         </select>
          
         <select class="form-control credit-card" id="cc_expiration_year" name="cc_expiration_year">
            <?php
               $yearRange = 20;
               $thisYear = date('Y');
               $startYear = ($thisYear + $yearRange);
             
               foreach (range($thisYear, $startYear) as $year)
               {
                  if ( $year == $thisYear) {
                     print '<option value="'.$year.'" selected="selected">' . $year . '</option>';
                  } else {
                     print '<option value="'.$year.'">' . $year . '</option>';
                  }
               }
            ?>
         </select>
         
            </td>
        </tr>
        <tr>
            <td class="display">CVC</td>
            <td><input name="cc_cvc" type="text" class="form-control cvc" id="cc_cvc" autocomplete="off" /></td>
        </tr>
            
        <tr>
            <td class="display">Email received voucher(s)</td>
            <td><input name="cc_email_recevied" type="text" class="form-control" id="cc_email_recevied" placeholder="Email received voucher(s)" value="<?php
                if (isset($_POST['txtEmailR']))                
                    echo $_POST['txtEmailR'];
                else
                    echo $this->session->userdata('email');
                ?>" /></td>
        </tr>
        <tr>
            <td></td>
            <td style="text-align: right;">
                <a class="button" href="javascript:doCheckout()" onclick="">Submit Order</a>
            </td>
        </tr>
    </table>
